When Antidepressants Don’t Relieve Hot Flashes, Gabapentin Might Help

To address concerns about risks associated with hormone therapy for treating women with menopausal vasomotor symptoms, the focus has shifted to nonhormonal treatments including antidepressants and the anticonvulsant gabapentin (see Journal Watch Women’s Health May 7 2003). For this 5-week trial, investigators randomized 118 women with hot flashes that were inadequately controlled by an antidepressant to receive both the antidepressant and gabapentin or gabapentin alone (after being weaned off the antidepressant). At study entry, about 75% of participants had a history of breast cancer, about two thirds were taking tamoxifen or an aromatase inhibitor, and most were taking venlafaxine or paroxetine.

Women completed baseline vasomotor symptom diaries for 1 week and then received gabapentin (300 mg) at bedtime for 3 days, twice daily for 3 days, and three times daily for 22 days. Those randomized to concurrent antidepressant therapy continued at their present dose; those randomized to discontinue were weaned off their antidepressants over 7 to 10 days. Regardless of whether or not antidepressants were continued, 91 evaluable participants reported about 50% reduction in the frequency of hot flashes at the 4-week assessment. By the end of week 2, women who discontinued antidepressants tended toward negative mood changes and nervousness. Self-reported quality-of-life parameters were similar in both groups throughout the study.